The Challenge of Indigenous Healing for Global Mental Health

Psychiatry and anthropology have a long relationship, and it is worth examining aspects of how that relation is carried over into the developing field of Global Mental Health (GMH). One place at which the two disciplines overlap significantly is in addressing religious phenomena and ritual performance in relation to mental health, and one of the greatest challenges for GMH is how productively to take into account forms of indigenous healing based on religion and ritual. In this paper I compare recent texts in GMH written from the standpoint of psychiatry and anthropology, observing that the psychiatric texts emphasize evidence-based determination of treatment efficacy, while the anthropological texts emphasize ethnographic understanding of treatment experience. Reconciling these two emphases constitutes a challenge to the field, attending to contextual variations in treatment events, illness episodes, phenomenological factors both endogenous and intersubjective, and sociopolitical factors both interpersonal and structural. In addressing this challenge, I propose an approach to therapeutic process that on the empirical level can facilitate comparison across the diversity of healing forms, and on the conceptual level can constitute a bridge between efficacy and experience. This approach is predicated on a rhetorical model of therapeutic process including components of disposition, experience of the sacred, elaboration of alternatives, and actualization of change that highlights experiential specificity and incremental change. Deploying this model can help meet the challenge of understanding efficacy and experience in indigenous healing, and prepare the ground for the further challenge of how practitioners of GMH relate to and interact with such forms of healing.

[Breast cancer: follow-up, rehabilitation, psycho- oncology]

Follow-up includes the permanent contact with and health education of the patient, the surveillance and control of the adverse effects of surgery, oncological therapies or radiotherapy, the screening of metachronous cancers, and the comprehensive (physical, psychological and social) rehabilitation of the patient which may be enhanced by healthy life-style. The early detection and curative management if necessary, of local/regional tumor relapse is still a priority but the routine screening of distant metastases by means of imaging studies or tumor marker tests is not justified. Supportive therapy means to endocrine therapy, available social support in Hungary, and the key issues and managing tools of physical and psychooncological care are provided. Individual solution of special issues (breast cancer risk/genetic mutation, pregnancy) may be served by widening options. Ideally, follow-up is practised by a cooperative team of oncologists, surgeons, breast radiologists, social workers, physiotherapists, psychiatrists. The follow-up approach should be comprehensive and holistic.

One Virus, Four Continents, Eight Countries: An Interdisciplinary and International Study on the Psychosocial Impacts of the COVID-19 Pandemic among Adults

The novel coronavirus disease 2019 (COVID-19) pandemic brought about several features that increased the sense of fear and confusion, such as quarantine and financial losses among other stressors, which may have led to adverse psychosocial outcomes. The influence of such stressors took place within a broader sociocultural context that needs to be considered. The objective was to examine how the psychological response to the pandemic varied across countries and identify which risk/protective factors contributed to this response. An online survey was conducted from 29 May 2020-12 June 2020, among a multinational sample of 8806 adults from eight countries/regions (Canada, United States, England, Switzerland, Belgium, Hong Kong, Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depression episode (MDE) were assessed. The independent role of a wide range of potential factors was examined using multilevel logistic regression. Probable GAD and MDE were indicated by 21.0% and 25.5% of the respondents, respectively, with an important variation according to countries/regions (GAD: 12.2-31.0%; MDE: 16.7-32.9%). When considered together, 30.2% of the participants indicated probable GAD or MDE. Several factors were positively associated with a probable GAD or MDE, including (in descending order of importance) weak sense of coherence (SOC), lower age, false beliefs, isolation, threat perceived for oneself/family, mistrust in authorities, stigma, threat perceived for country/world, financial losses, being a female, and having a high level of information about COVID-19. Having a weak SOC yielded the highest adjusted odds ratio for probable GAD or MDE (3.21; 95% confidence interval (CI): 2.73-3.77). This pandemic is having an impact on psychological health. In some places and under certain circumstances, however, people seem to be better protected psychologically. This is a unique opportunity to evaluate the psychosocial impacts across various sociocultural backgrounds, providing important lessons that could inform all phases of disaster risk management.

The health effects of work-family conflict in men and women Japanese civil servants: a longitudinal study

High level of work-family conflict (WFC) is an important risk factor for stress-related health outcomes. However, many studies are cross-sectional studies. In this study, we aimed to clarify how changes in WFC levels over a period 5 yr can affect workers' mental and physical health, and to clarify whether there are gender differences of them. This study examined 1,808 civil servants (1,258 men and 550 women) aged 20-65 yr working in a local government in the west coast of Japan from 2003 to 2008. Logistic regression analyses were used to examine whether the change in WFC contributes to workers' health problems and whether there are gender differences. This study revealed association sustained high WFC and deterioration of WFC conflict with poor mental health and poor job satisfaction for both men and women. In men high WFC conflict and deterioration was associated with poor mental health (OR=2.74). On the other hand, women had strong relationship between WFC changes and poor physical health (OR=2.64). WFC was an important factor as a social determinant of health of Japanese civil servants, and the change in WFC affects subsequent health problems with different trends in men and women.

Factors that Influence the Decision to Seek Help in a Police Population

Police officers face many competing pressures and demands. Exposure to potentially traumatic incidents and significant job-related stressors can place many at higher risk of developing physical and mental health problems. The police culture exerts a pronounced influence on officers, preventing some from asking for or receiving assistance. The stigma of being perceived as weak or incompetent, concerns about being labelled unfit for duty, and worry that accessing psychological support will impact future career advancement can affect the decision to seek help. The Enhanced Critical Incident Technique was utilized to investigate the following research question: What helps or hinders the decision to access psychological services in a police population? Qualitative interviews were conducted with 20 serving Royal Canadian Mounted Police officers in the lower mainland of British Columbia, Canada. The findings encompass five main themes: the importance of systemic factors, access to information and education, quality and influence of relationships, individual characteristics, and organizational processes that will increase the likelihood of accessing mental health services. The results contribute to the empirical literature by enhancing what is known about elements that influence an officers' decision to seek psychological services, and factors that can enable officers to overcome barriers.

Effects of Cognitive Behavioral Group Program for Mental Health Promotion of University Students

This study aimed to explore the effects of a group cognitive behavioral program on depression, self-esteem, and interpersonal relations among undergraduate students. A non-equivalent control group pretest-posttest design was used. A convenient sample of 37 undergraduates (18 in the experimental group and 19 in the control group) at K university located in Changwon, South Korea was used. Data were collected from February 4, 2019 to June 18, 2019. The experimental group received eight sessions of the program, which were scheduled twice a week, with each session lasting 90 min. Collected data were analyzed using a chi-square test, Fisher’s exact test, independent t-test, and repeated measures ANOVA by SPSS/WIN 23.0 (SPSS, Inc., Chicago, IL, USA). The interaction of group and time was significant, indicating that the experimental group showed an improvement in depression, self-esteem, and personal relationship compared to the control group. A significant group by time interaction for depression, self-esteem, and personal relationship was also found between the two groups. The study results revealed that the group cognitive behavioral program was effective in reducing depression and improving self-esteem and interpersonal relation. Therefore, the group cognitive behavioral program can be used for promoting the mental health of students as well as for preventing depression in a university setting.

The Interactive Effects of Personal Resources on Teachers' Work Engagement and Withdrawal Intentions: A Structural Equation Modeling Approach

This research contributes to the current knowledge on teacher well-being by examining an integrated model with a personal resource (i.e., emotional intelligence) explaining teacher withdrawal intention through a mediator (i.e., work engagement) and considering the moderator effect of a second personal resource (i.e., teacher self-efficacy) in this relationship. Adopting a cross-sectional design, a total of 702 teachers (63.2% female) working at different educational levels took part in this study. The results showed that emotional intelligence and teacher self-efficacy were positively related to work engagement and negatively related to withdrawal intentions. Most importantly, the results demonstrated support for the hypothesized model-that is, teacher self-efficacy moderated the relationship between emotional intelligence and work engagement. Taken together, our findings highlight both emotional intelligence and teacher self-efficacy as positive individual resources for increased work engagement and reduced withdrawal intentions. This study has implications for the development of intervention programs aiming at increasing occupational well-being in educational settings.

[Mental health status and its influencing factors among college students during the epidemic of COVID-19]

OBJECTIVE

To investigate the mental health status of college students during the epidemic of COVID-19 and identify the factors influencing the mental health of the students.

METHODS

Using a general questionnaire, a self-designed new coronavirus pneumonia knowledge and cognitive behavior questionnaire, the Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9), we conducted an internet-based questionnaire survey of 3881 college students in Guangdong Province. A multinomial-logistic regression model was used to analyze the collected data.

RESULTS

The survey showed that 69.47% of the college students had a high level of awareness of COVID-19; the overall incidence of anxiety was 26.60%, and the incidences of mild, moderate and severe anxiety were 23.19%, 2.71%, and 0.70%, respectively. Depressive emotions were detected in 21.16% of the students, and the incidences of mild, moderate, and moderate-to-severe depression were 16.98%, 3.17%, and 1.01%, respectively. The results of multivariate analysis showed that an older age was associated with a higher level of awareness of COVID-19 and greater changes in future health behaviors were associated with less anxiety and depression among the students. The students currently in rural areas, of non-medical majors, and reporting half of their information concerning the epidemic being negative were more likely to have anxiety; female gender, residence in suburbs, a drinking history, and excessive negative information concerning the epidemic were all associated with the likeliness of depression.

CONCLUSIONS

The college students have different levels of anxiety and depression during the epidemic. Depression and anxiety are closely related, but the factors contributing to different levels of such emotions can be different, and colleges and related departments are urged to provide precision mental health education for college students.

Six-Step Model of Nature-Based Therapy Process

Several studies have confirmed that the natural environment has psychophysiological healing effects. However, few studies have investigated the healing process involved in the effect of the natural environment. To date, no theoretical model on the nature-based therapy process has been clearly established. Thus, the aim of this study was to develop a theoretical model of the nature-based therapy process by analyzing individual empirical data. Research materials were 180 self-reported essays on “Forest Therapy Experiences” submitted to the Korea Forest Service. This study was conducted based on grounded theory. Data were analyzed through open coding. A total of 82 concepts, 21 subcategories, and six categories were derived. Results revealed that the nature-based therapy process contained six categories: Stimulation, acceptance, purification, insight, recharging, and change. When in the natural environment, participants first experienced positive emotional change, followed by cognitive and behavioral changes. Based on these results, a nature-based therapy process model was derived. This study revealed that the nature-based therapy process did not consist of just a single element or step, but involved an integrated way of healing with emotional and cognitive changes. This study is significant in that it derives a theoretical model of the nature-based therapy process with comprehensive mechanisms. Further research is needed to establish more systematic theoretical model.

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model

Research suggests that poverty is a key driver of intimate partner violence (IPV), however detailed analysis suggests that this relationship is not clear, either for women’s experience or men’s perpetration of IPV. We explored associations between poverty and IPV using cross-sectional data from the Stepping Stones and Creating Futures cluster randomized control trial, in urban informal settlements in Durban, South Africa, with young (18–30) people. Using logistic regression and structural equation modelling we assess associations between poverty and women’s experience and men’s perpetration of physical and/or sexual IPV in the past 12 months. 680 women and 677 men were recruited into the study between September 2015 and September 2016. The analyses highlight how specific forms or measures of poverty intersecting with gender identities shape IPV. For men we found indicators of economic provision were associated with IPV perpetration, while for women food-insecurity was key to IPV experience. We also found similarities between women and men. First, food-insecurity and childhood traumas shaped pathways to substance misuse and poor mental health that increased IPV. Second, there was a resilience pathway in both models, whereby those with more education had increased gender equitable attitudes and fewer controlling behaviours, which reduced IPV. Interventions to reduce IPV need to work to reduce household food insecurity, but these need to be combined with gender transformative interventions. Interventions should also focus on reducing the impact of mental health and substance misuse. Finally, working to increase educational attainment is a long-term critical intervention to reduce IPV.

Trial registration:NCT03022370. Registered 13 January 2017, retrospectively registered.

Body-Mind Healing Strategies in Patients with Cancer: a Qualitative Content Analysis

Background: Cancer is a major health problem around the world. The use of coping strategies among patients with cancer depends on several issues. This study was conducted to determine coping strategies used by patients with cancer in south-east Iran. Methods: This study is a conventional, qualitative content analysis with a descriptive explorative approach. Data saturation achieved after interviewing 13 participants in 15 interviews. Using an in-depth individual semi-structured approach the participants were asked to narrate their experiences of strategies that they used to cope with cancer. The following were considered: unit of analysis, meaning unit, condensation, code, sub-category, category, and main category. Results: Data analysis led to extraction of two main categories of body-mind healing strategies: being connected to the body and mindfully reconnected to the self. The first category was explained with reference to two sub-categories, being aware of intelligence and body nurturing. The second category was explained with the three sub-categories of using embodying knowledge, living for the moment, and being connected to nature. Conclusion: According to the results of this qualitative study, it is possible to form discussion groups with peers or to have self-reflective practice learning groups to reflect patients’ questions and strategies that they use for body-mind healing.

The Burden of Stigma on Health and Well-Being: A Taxonomy of Concealment, Course, Disruptiveness, Aesthetics, Origin, and Peril Across 93 Stigmas

Most individuals are stigmatized at some point. However, research often examines stigmas separately, thus underestimating the overall impact of stigma and precluding comparisons across stigmatized identities and conditions. In their classic text, Social Stigma: The Psychology of Marked Relationships, Edward Jones and colleagues laid the groundwork for unifying the study of different stigmas by considering the shared dimensional features of stigmas: aesthetics, concealability, course, disruptiveness, origin, peril. Despite the prominence of this framework, no study has documented the extent to which stigmas differ along these dimensions, and the implications of this variation for health and well-being. We reinvigorated this framework to spur a comprehensive account of stigma's impact by classifying 93 stigmas along these dimensions. With the input of expert and general public raters, we then located these stigmas in a six-dimensional space and created discrete clusters organized around these dimensions. Next, we linked this taxonomy to health and stigma-related mechanisms. This quantitative taxonomy offers parsimonious insights into the relationship among the numerous qualities of numerous stigmas and health.

[When the trap closes in]

The poignant testimony of Anne L. illustrates perfectly how the spiral of an abuser's hold closes around the victim. She describes how she met Charles and how their relationship, between passionate love and hate, hope and disillusion, progressed from psychological war to beatings, resulting in absolute domination. Supported today by a specialised network, even though she has managed to leave him, many questions remain for this victim and her scars are far from healed.

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

Evolutionary continuity and personhood: Legal and therapeutic implications of animal consciousness and human unconsciousness

Convergent lines of research in the biological sciences have made obsolete the commonly held assumption that humans are distinct from and superior to all other animals, a development predicted by evolutionary science. Cumulative evidence has both elevated other animals from the status of "dumb brutes" to that of fully sentient and intentional beings and has simultaneously discredited elevated claims of human rationality, intentionality, and freedom from the constraints experienced by other animals. It follows then that any theoretical model in which humans occupy the top of an imagined evolutionary hierarchy is untenable. This simple fact calls for a rethinking of foundational concepts in law and health sciences. A further cultural fallacy that is exposed by these converging lines of scientific evidence is the notion that the subjective inner and abstract dimension of human beings is the most true and valuable level of analysis for organizing human lives. In fact, our individual and collective minds are particularly vulnerable to elaborated false narratives that may be definitive of the particular forms of suffering that humans experience and seek to heal with modalities like psychoanalytic psychotherapies. I conclude with the suggestion that other animals may have the capacity to help us with this healing project, even as we are ethically bound to heal the suffering that we have collectively imposed upon them.

Unchained melody: revisiting the estimation of SF-6D values

PURPOSE

In the original SF-6D valuation study, the analytical design inherited conventions that detrimentally affected its ability to predict values on a quality-adjusted life year (QALY) scale. Our objective is to estimate UK values for SF-6D states using the original data and multi-attribute utility (MAU) regression after addressing its limitations and to compare the revised SF-6D and EQ-5D value predictions.

METHODS

Using the unaltered data (611 respondents, 3503 SG responses), the parameters of the original MAU model were re-estimated under three alternative error specifications, known as the instant, episodic, and angular random utility models. Value predictions on a QALY scale were compared to EQ-5D3L predictions using the 1996 Health Survey for England.

RESULTS

Contrary to the original results, the revised SF-6D value predictions range below 0 QALYs (i.e., worse than death) and agree largely with EQ-5D predictions after adjusting for scale. Although a QALY is defined as a year in optimal health, the SF-6D sets a higher standard for optimal health than the EQ-5D-3L; therefore, it has larger units on a QALY scale by construction (20.9 % more).

CONCLUSIONS

Much of the debate in health valuation has focused on differences between preference elicitation tasks, sampling, and instruments. After correcting errant econometric practices and adjusting for differences in QALY scale between the EQ-5D and SF-6D values, the revised predictions demonstrate convergent validity, making them more suitable for UK economic evaluations compared to original estimates.

Childhood adversity and subsequent mental health status in adulthood: screening for associations using two linked surveys

AIMS

Accumulating evidence links childhood adversity to negative health outcomes in adulthood. However, most of the available evidence is retrospective and subject to recall bias. Published reports have sometimes focused on specific childhood exposures (e.g. abuse) and/or specific outcomes (e.g. major depression). Other studies have linked childhood adversity to a large and diverse number of adult risk factors and health outcomes such as cardiovascular disease. To advance this literature, we undertook a broad examination of data from two linked surveys. The goal was to avoid retrospective distortion and to provide a descriptive overview of patterns of association.

METHODS

A baseline interview for the Canadian National Longitudinal Study of Children and Youth collected information about childhood adversities affecting children aged 0-11 in 1994. The sampling procedures employed in a subsequent study called the National Population Health Survey (NPHS) made it possible to link n = 1977 of these respondents to follow-up data collected later when respondents were between the ages of 14 and 27. Outcomes included major depressive episodes (MDE), some risk factors and educational attainment. Cross-tabulations were used to examine these associations and adjusted estimates were made using the regression models. As the NPHS was a longitudinal study with multiple interviews, for most analyses generalized estimating equations (GEE) were used. As there were multiple exposures and outcomes, a statistical procedure to control the false discovery rate (Benjamini-Hochberg) was employed.

RESULTS

Childhood adversities were consistently associated with a cluster of potentially related outcomes: MDE, psychotropic medication use and smoking. These outcomes may be related to one another since psychotropic medications are used in the treatment of major depression, and smoking is strongly associated with major depression. However, no consistent associations were observed for other outcomes examined: physical inactivity, excessive alcohol consumption, binge drinking or educational attainment.

CONCLUSIONS

The conditions found to be the most strongly associated with childhood adversities were a cluster of outcomes that potentially share pathophysiological connections. Although prior literature has suggested that a very large number of adult outcomes, including physical inactivity and alcohol-related outcomes follow childhood adversity, this analysis suggests a degree of specificity with outcomes potentially related to depression. Some of the other reported adverse outcomes (e.g. those related to alcohol use, physical inactivity or more distal outcomes such as obesity and cardiovascular disease) may emerge later in life and in some cases may be secondary to depression, psychotropic medication use and smoking.

Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique

BACKGROUND

Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert.

OBJECTIVES

We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries.

CONCLUSIONS

Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide.

Scar Tissue

Scar tissue is associated with physical wounds and their mending, but it is also descriptive in portraying the emotional scarring that occurs following adversity, resulting in potential psychological morbidity. Provided the adversity is not severe, such challenges to adaptability may provoke Andrew Solomon's process of forging meaning and building identity. Perceiving an emotional constitution as analogous to the immune system provides a metaphor for appreciating the benefits of emotional challenges, which may provoke greater emotional resilience or posttraumatic growth.

Words that heal

The value of words in the healing process runs constant to the path of therapeutic treatment, the net of exchanges and relationships between brain chemistry and the right words in order to heal is subtle and intricate. Psychotherapy, a treatment with words, is shown to be a treatment that directly affects the brain and that is able to change it stably, even in its anatomical structure and function. According to Kandel (1999), a leading living scientist and Nobel Prize winner for medicine and physiology, American neurologist and psychiatrist, psychotherapy is a real cure, a biological treatment, as it produces behavioral changes through new words and new experiences. The article offers a brief overview of the use of the fantasy of argument, since the time of the classical rethoric of the sophists up to the new rethoric, to illustrate how the structure of the speech, and the dialectic ability of opposing different thoughts, closely resembles the way of thinking. Consequently the choice of words can be considered an instrument of great impact that is inserted in the stream of thoughts that determines the attitude of a person, and therefore, his/her actions. This happens whenever you communicate voluntarily, and not simply when interacting. The right choice of words remains a turning point in all of our relationships, not only in therapeutic situations, but in every other social relationship in life, family or friends.

Tattoo as art, the drivers behind the fascination and the decision to become tattooed

For many people, getting a tattoo is like purchasing art, and many professional and famous tattooists are artists who are acknowledged by colleagues and authorities. The history of tattooing goes back for thousands of years, and the reasons for getting tattooed are many. These permanent markings are always personal, they can be plain or elaborate, and they serve as amulets, healing and status symbols, declarations of love, signs of religion, adornments and even forms of punishment. Drivers behind the fascination of acquiring a tattoo may fall into four main groups, namely healing, affiliation, art and fashion.

Reliability and validity of the work role functioning questionnaire (Spanish version)

PURPOSE

Recently, the cross-cultural adaptation of the Work Role Functioning Questionnaire to Spanish was carried out, achieving satisfactory psychometric properties. Now we examined the reliability and validity of the adapted [Work role functioning questionnaire-Spanish version (WRFQ-SpV)] in a general working population with and without (physical and mental) health issues to evaluate its measurement properties.

METHODS

A cross-sectional study was conducted among active workers. For reliability, we calculated Cronbach alphas to assess 'internal consistency', and the standard error of measurement (SEM) to evaluate 'measurement error'. We assessed the 'structural validity' through confirmatory factor analyses and 'construct validity' by means of hypotheses testing. The consensus-based standard for the selection of health status measurement instruments (COSMIN) taxonomy were used in the design of the study.

RESULTS

A total of 455 workers completed the questionnaire. It showed excellent internal consistency (α = 0.98). The SEM for the overall scale was 7.10. The original five factor structure reflected fair dimensionality of the construct (Chi square, 1,445.8; 314 degrees of freedom; root mean square error of approximation = 0.08; comparative fit index >0.95 and weighed root mean residual >0.90). For construct validity, all hypotheses were confirmed differentiating groups with different jobs, health conditions and ages. Moderate to strong correlations were found between WRFQ-SpV and a related construct (work ability).

CONCLUSIONS

Our study provides evidence of the reliability and validity of the WRFQ-SpV to measure health-related work functioning in day-to-day practice and research in occupational health care and the rehabilitation of disabled workers. It should be useful to monitor improvements in work functioning after implementing rehabilitation and/or accommodation programs. Longitudinal studies are needed to assess the responsiveness of the questionnaire.

The werther effect of two celebrity suicides: an entertainer and a politician

Purpose

Suicide is a major health problem in Korea. Extensive media exposure of celebrity suicide may induce imitative suicide, a phenomenon called the Werther effect. We examined the increased suicide risk following the suicides of an entertainer and a politician, and identified the relative suicide risks.

Methods

News articles about the celebrity suicides were obtained from three major newspapers and analysed for quantitative and qualitative features. Imitative suicide risk was investigated by applying a Poisson time series autoregression model with suicide mortality data from the National Statistics Office for 1.5 years before and 1.5 years after each celebrity’s suicide. The period with a significantly increased number of suicides immediately after the celebrity’s suicide determined the Werther effect band. The relative risk during this period was examined for different ages, genders, and suicide methods.

Results

News reports were more numerous and they contained more positive definitions about the entertainer’s suicide. The risk of suicide deaths rose markedly after both celebrity suicides. However, the Werther effect band was longer for the entertainer (6 weeks) than for the politician (4 weeks). The relative suicide risk was significant for almost all ages and both genders during that of both individuals. Use of the same suicide method was a prominent risk factor after both celebrity suicides.

Conclusions

Our results confirm the existence of imitative suicide behaviours, suggesting a facilitation effect of media reports. Guidelines for responsible media reporting need to be implemented to enhance public mental health in Korea.

[Distant mental influence on living organisms]

This article reviews studies of distant mental influence on living organisms, including mental suggestions of sleeping and awakening, mental influence at long distances, mental interactions with remote biological systems, mental effects on physiological activity and the sense of being stared at. Significant effects of distant mental influence have been shown in several randomized controlled trials in humans, animals, plants, bacteria and cells in the laboratory. Although distant mental influence on living organisms appears to contradict our ordinary sense of reality and the laws defined by conventional science, several hypotheses have been proposed to explain the observed effects; they include skeptical, signal transfer, field, multidimensional space/time and quantum mechanics hypotheses. In conclusion, as the progress of physics continues to expand our comprehension of reality, a rational explanation for distant mind-matter interaction will emerge and, as history has shown repeatedly, the supernatural events will evolve into paranormal and then, into normal ones, as the scientific frontiers expand.

'Chaos, restitution and quest': one woman's journey through menopause

Menopause, a natural stage in a woman's reproductive life, is not an illness; yet some women experience severe enough symptoms to cause a breakdown in the body similar to illness or other major health disruptions. As part of a larger narrative analysis investigation of distress during menopause, this case study presents one woman's transformational journey through menopause, analysed through Frank's health and illness narratives - chaos, restitution and quest. The narratives were retranscribed using Labov's elements of a true story and Gee's poetic restructuring. This report of one woman's experience of distress during the menopause transition describes a poetic chaos narrative of incessant night sweats resulting in a loss of physicality and a deep-rooted belief in self-healing; a restitution narrative of restored health that mandated the surrender to a new healing discourse, experienced simultaneously as a victory and a defeat; and a quest narrative of seeking meaning, insight and new-found values and identities.

Transforming the self and healing the body through the use of testimonies in a divine retreat center, Kerala

In this article, we analyze the collective healing process that takes place on a weekly basis in the Divine Retreat Center (DRC) in Muringoor, Kerala. We argue that disease in the DRC is understood either as a psycho-somatic or as a spirito-somatic phenomenon. In contrast to other Charismatic communities, however, the body is the locus on which the medical effects of the healing become visible. The whole process is divided into several phases: First, there is a cleansing and disengagement procedure that aims to purify and liberate the participants through confession and counseling. Thereafter comes a climatic phase of personal emptying, transition and re-orientation during which the healing itself takes place. The procedure is finally completed with the person being spiritually "refilled" by the Holy Spirit. The dominant recurring element in the whole process is the continuous statement of healing "testimonies." As an integral part of the healing procedure, these statements are used to share personal experiences among the participants in the center. They are produced in a strict format in order to be spread far beyond through various media (TV, newspaper, Internet, etc.). They thereby constitute a speech genre that follows specific rules and patterns. Through shaping one's own biography in the frame of the testimonies, so we argue, the actual transformation of the self and therefore the miracle healing takes place.